MEDICARE: HOLLY CASE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821124330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY CASE

Provider Business Mailing Address
First Line	:	4411 TREEHOUSE LN
Second Line	:	24-H
City	:	TAMARAC
State	:	FL
Zip	:	33319-3376
Country	:	US
Telephone Number	:	954-763-4236
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 N STATE ROAD 7
Second Line	:	BUILDING B
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5860
Country	:	US
Telephone Number	:	954-730-7284
Fax Number	:	954-497-3857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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Directions to “ HOLLY CASE ” Practice Location

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